Constipation in Infants: Causes and Solutions

It has been several days since I last had a bowel movement?

Hello, doctor.
My baby is currently four months old.
She started having episodes of intense crying and screaming at three and a half months.
Initially, she was drinking a little breast milk mixed with formula, but after half a month, we switched to full formula feeding.
However, she has been unable to sleep well at night and needs to be held and rocked at specific times to fall asleep.
We switched to Abbott formula, but the situation did not improve (based on the timing and my online research, I suspect it might be colic).
When she was one month old, during a health check and vaccination, the doctor noted that she had a bloated belly and was passing a lot of gas.
Afterward, I consulted a pharmacy about formula, and they recommended Similac for gas relief, which helped reduce the symptoms and her bowel movements became normal (she has been having bowel movements almost every day).
However, by three months, she started having pellet-like stools.
At three and a half months, she had another episode of intense crying, so we took her to the doctor again.
The doctor recommended trying Nestlé hydrolyzed formula (since we had tried various formulas without improvement and she still had a lot of retained stool).
The doctor also prescribed medication for her.
On the first day, her bowel movement was very foul-smelling, and she cried again at noon, so we switched back to Similac.
She seemed tired, so she slept well that night until morning.
The next night, however, she had another episode of intense crying.
On the third morning, she had another foul-smelling bowel movement.
I asked my husband to take her to the doctor again, and we switched medications.
After four days without a bowel movement, we took her back to the doctor, who finally prescribed "gastric emulsion." It has now been two days without a bowel movement, which worries me.
Can you tell me if "gastric emulsion" will help her have a bowel movement? (I have been giving her water, massaging her belly, and she has been passing gas, which is also foul-smelling, but she still hasn't had a bowel movement.
She is straining but to no avail.
During the doctor's visits, she has received enemas that helped her have bowel movements.
Her overall health seems fine.) Thank you, doctor.

Xinshou Xu Mama, 20~29 year old female. Ask Date: 2017/05/03

Dr. Xiao Kaiwen reply Pediatrics

Infants have immature muscles for bowel movements, which may result in difficulty passing stool at times.
As they grow older and begin to consume solid foods (such as vegetable and fruit purees that are high in fiber), this situation typically improves.
Magnesium-containing antacids, such as milk of magnesia, can help soften stools.
However, if an infant over one month old continues to have difficulty with bowel movements, it is advisable to consult a pediatric gastroenterologist at a major hospital to rule out rare conditions such as megacolon or other structural issues.

Reply Date: 2017/05/03

More Info

Constipation in infants can be a distressing issue for both the child and the parents. Understanding the causes and potential solutions is essential for managing this condition effectively.

Causes of Constipation in Infants
1. Dietary Changes: One of the most common causes of constipation in infants is a change in diet. When transitioning from breast milk to formula, or even between different types of formula, a baby’s digestive system may take time to adjust. Formula-fed infants are more prone to constipation compared to breastfed infants, as breast milk contains natural laxatives and is easier to digest.

2. Dehydration: Infants may not be getting enough fluids, especially if they are primarily on formula. Dehydration can lead to harder stools, making it difficult for the baby to pass them.

3. Lack of Fiber: As infants begin to eat solid foods, a lack of fiber in their diet can contribute to constipation. Foods that are low in fiber can lead to harder stools.

4. Medical Conditions: In some cases, constipation can be a sign of an underlying medical condition, such as a metabolic disorder or gastrointestinal issues.
5. Changes in Routine: Stressful events or changes in routine, such as traveling or changes in caregivers, can also affect an infant's bowel habits.

Solutions for Managing Constipation
1. Dietary Adjustments: If your infant is on formula, consider discussing with your pediatrician about trying a different formula that may be easier on their digestive system. Some formulas are specifically designed to reduce gas and constipation. If your baby has started solids, introduce high-fiber foods like pureed prunes, pears, or peas, which can help soften stools.

2. Hydration: Ensure your infant is adequately hydrated. If they are older than six months, small amounts of water can be introduced. For younger infants, ensure they are getting enough formula or breast milk.

3. Tummy Massage: Gentle tummy massages can help stimulate bowel movements. You can try moving your hands in a circular motion on your baby’s belly or gently pushing their knees towards their tummy.

4. Bicycle Legs: Moving your baby’s legs in a bicycle motion can help relieve gas and stimulate bowel movements.

5. Warm Baths: A warm bath can help relax the abdominal muscles and may encourage a bowel movement.

6. Consulting a Pediatrician: If constipation persists, it is crucial to consult a pediatrician. They may recommend medications such as glycerin suppositories or other treatments. The use of “胃乳液” (gastric emulsion) may help in some cases, but it is essential to follow the pediatrician's guidance on its use.

7. Monitoring Bowel Movements: Keep track of your baby’s bowel movements, noting the frequency, consistency, and any associated symptoms like crying or discomfort. This information can be helpful for your pediatrician in diagnosing the issue.

8. Avoiding Overuse of Laxatives: While it may be tempting to use laxatives or enemas frequently, these should only be used under the guidance of a healthcare professional, as overuse can lead to dependency or worsen the problem.

Conclusion
Constipation in infants can be a complex issue influenced by various factors, including diet, hydration, and routine changes. It is essential to approach the situation with patience and to consult with a healthcare provider for tailored advice. Regular follow-ups with your pediatrician can help ensure that your infant's digestive health is on track and that any underlying issues are addressed promptly. Remember, every infant is different, and what works for one may not work for another, so personalized care is key.

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